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Oct. 28. 2013 9: 58AM EVERGREEN STATE HEAT & AC No. 8839 P. 1 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-6657—www.everettwa.org <br /> _ APPLICATIONS ARE ACCEPTEI3 FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX If PERMIT# <br /> 2 fr <br /> AA 0 I ,8 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER I)JLwbzC)1)1 01_ Phone/E-mail <br /> Address Clly/Stale <br /> _.... 2ip E E( C�8 <br /> CONTRACTOR &Area.�P 7v 'c cZ fle z-E 4(1 L&1 LIc.# VE RRSS0 zflC— <br /> Address I ZD PA-GL L Phone/Email < J 25Z- <br /> 31 (c-F- <br /> TENANT BUSINESS NAME - CONTACT' R PERMIT <br /> -{`l3A(,OSOV C `u2S1 Z5Z 3(rt(WlZOC5� AL . ,, ii. <br /> Phone/E-mail /< os�7ol�sSfyuddol.( <br /> BUILDING PERMAPPLIC <br /> . CONTRACT PRICE OF WORK lj OOO, <br /> Existing Use of Building . _ • HEAT SOURCE: <br /> Proposed Use of Building Gas)'C Eieclrtc Other <br /> Building type: _Single Family _Duplex Townhouse _Multi-Family _Commercial <br /> Type of project: —New _Addition _Remodel Repair . T.I._Sign_Sprinkler Demolition Change of Use <br /> Description of Work(additional space provided on the back): f , <br /> Rei.„oc4rr G�ctyrrl•IG, 1'' it F/Eli-11any •�L.i�ue5 <br /> Have you started working without a permit? . YES Y---140 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: NewAddn Alteration•Repair Type of Project: New_Addn _Alteration`Repair <br /> Show Number(14)of fixtures Show Number(0)of fixtures <br /> NC—air handling units Toilet <br /> Forced air systems Bathtub • <br /> 1 Gas piping • Lavatory(wash basin) <br /> Water heater Shower <br /> ' Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Ran.e hood Water heater <br /> Exhaust fan Sink service/bar/mop/1310 <br /> Heat pump Backflow preventer <br /> 1 Unit heater Urinal <br /> • Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other <br /> I - Number of Heads Other <br /> I hereby certify that I have read and eXanllned this application and know the same to be true and correct.All provisions of laws and ordinances governing <br /> this type of vwrk will be complied with whether specified herein or not.The granting Ole permit does not presume to give authority to violate or cancel <br /> the provisl n of ny other state law regulating construction or the performance of construction,Thal I am authorized by the omer of this property <br /> to perfor lh ►svrk for whl pllcali n Is made and I comply with the Stale Contractors Law 16,27 RCW and 296.200 WAC <br /> /0 —Z6-.13 <br /> Owner/Authorized Agent Signature Date (Revised 2/2011) <br />